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Two recent papers show that studying lymph nodes reveals details of the mechanisms of autoimmunity.

Rituximab abrogates aquaporin-4–specific germinal center activity in patients with neuromyelitis optica spectrum disorders (PNAS)

Cervical lymph nodes and ovarian teratomas as germinal centres in NMDA receptor-antibody encephalitis (Brain)

These studies open up avenues to better and more accurately study the immune system of patients with autoimmunity, presenting insights into their biology and therapeutics.
- Professor Sarosh Irani

Autoimmunity affects up to 10 per cent of humans, and includes conditions such as types of diabetes and thyroid diseases. More recently, a group of conditions have been identified in which the central nervous system (brain and spine) are affected by autoantibodies, made by our immune systems.

The generation of autoimmunity often occurs in the body's lymph nodes. However, typically, blood has been examined to infer lymph node function, mainly as lymph nodes are less easily accessible. In fact, to date the role of lymph nodes has not been directly studied in humans with autoantibodies.

Here, in two parallel studies, researchers sampled lymph nodes in the neck, which are thought to drain the central nervous system, in patients with autoantibodies that affect their spine and brain. Studying the lymph nodes revealed immunological findings which were very different to those revealed by blood. Lymph node sampling was more accurate in identifying the mechanisms by which the autoantibodies were produced and better correlated with the clinical efficacy of treatments administered to the patients.